Pressors in Surgery Center?!

[Jen04 nurse]

I just wanted to get a consensus that I'm not going crazy or if you've ever heard of this before.

So I have had over 14 yrs of nursing experience in ICU, PACU, agency etc.

This new place I'm working basically is an ambulatory surgical center only considered a hospital because there is a one room ER- no ICU etc. Most of the nurses here have not done ICU, ER, or any critical care esp no training in hemodynamics etc.

The nurse mgrs have req training on using a smart pump for adm of vasopressors in the event of an emergency.

I feel this is more dangerous and a high liability to put vasoative drugs in the hands of nurses who have never been educated and expect it to be safe. The nurses would be mixing these as well. Not to mention it would be through PIVs since there are not docs that could start a central line here.

I'd love to hear what other nurses with experiemce in various settings think about this.

[Wuzzie]

Actually in most jurisdictions even a hospital can call 911 in the event they have an emergent transfer and are unable to use any other means to get the person to a hospital that can handle their care.

Annie

If there's no other way of course but I believe most tertiary hospitals have some sort of transport system. I live in a huge metropolitan area. Our 911 service does not hang or run pressors nor does the local ALS service. But we also have two separate adult CCT services so YMMV.

FTR-I am in no way saying that 911 couldn't handle it. I am a medic as well as a nurse. I'm just saying in my region it is dealt with differently.

[JKL33]

For a variety of reasons I'm not sure that patients who receive treatment at such a place will believe they are being cared for by nurses who, although they may have no experience managing the situations in question and although the facility admin doesn't find it necessary to hire people with said experience or else provide education, have been given the responsibility of making sure they know how to to xyz mechanical thing/task that is associated with such situations, to say nothing of the critical thinking aspect.

I guess I'm not as confident in the self-education method of nurses learning the specifics of caring for patients in their area/specialty. Maybe that's why it's generally not the way staff education is approached.

[Forest2]

Requiring education on the pump but not on the drugs being administered on the pump seems very irresponsible. Try suggesting a class on pressors and see what the response is. Or better yet present the benefits of having a course and ask to present one. Not all nurses initiate their own education. I for one research things I need to know and learn on my own. Take courses, etc, but a lot of nurses are not like that and don't realize what kind of trouble they can get into with certain drugs. It is very possible the managers are not even aware of the possible problems. Just a thought.

[MunoRN, RN]

A place that is technically a hospital can't just call 911. They need a more formal arrangement in place. I'm not sure if you're part of a bigger system and your providers can admit at more equipped facilities?

That's only true if it's an actual hospital, what's being described is a surgery center that presents itself as a type of hospital, which isn't unusual, often calling themselves a "medical center" and trying to market themselves as equivalent to having surgery in an actual hospital.

"Freestanding ER" is another example of this. While there are actual freestanding ER's, that are an offsite yet internal unit of an affiliated hospital, most places calling themselves a freestanding "ER" are just re-branded urgent care facilities.

[offlabel]

I would also want to be careful you're not missing sepsis by using them, by correlating clinical condition. Obviously, all this is contingent on proper education.

If you're starting a pressor on a patient with sepsis in an outpatient surgical center PACU, by definition, you've missed it.

[Julius Seizure]

That's only true if it's an actual hospital, what's being described is a surgery center that presents itself as a type of hospital, which isn't unusual, often calling themselves a "medical center" and trying to market themselves as equivalent to having surgery in an actual hospital.

"Freestanding ER" is another example of this. While there are actual freestanding ER's, that are an offsite yet internal unit of an affiliated hospital, most places calling themselves a freestanding "ER" are just re-branded urgent care facilities.

I don't care what they call themselves; all I want to know is what category my insurance is going to bill me for (urgent care is so much cheaper).